Shots - Health News

5:03 pm

Wed April 9, 2014

Why My Wife Didn't Choose A Double Mastectomy

Yet another entertainment figure has gone public with her decision to have a double mastectomy after a breast cancer diagnosis. Samantha Harris is the latest in a series of entertainers who've decided on that surgery as treatment for the disease.

Harris, a 40-year-old mother of two and former co-host of Dancing with the Stars, said she chose this procedure after consulting with three specialists. It was a difficult choice, she reports, but she feels it enabled her "to take control" and that she is "so much calmer."

As the husband of a breast cancer survivor, I can relate to what Harris says. A welcome sense of control and calm follows the agony of wrestling with treatment options.

I have also learned that a double mastectomy is not the best choice for all breast cancer patients. Nor does it eliminate fear of recurrence.

Nonetheless, double mastectomies are on an extraordinary upward swing in the United States.

"Twenty years ago, only 1 to 2 percent of women with cancer in one breast made that choice," says Dr. Todd Tuttle, chief of surgical oncology at the University of Minnesota. "Now the rates are 15, 20, 25 percent."

Many of those women have a sound medical rationale for selecting double mastectomy. It is appropriate treatment for a patient diagnosed with cancer in one breast and at high risk for recurrence because of family history. A double mastectomy is also recommended for women not yet diagnosed if they carry the BRCA1 or 2 gene, with its high risk of developing the disease. That was the case for actress Angelina Jolie.

The rates may have risen in part because genetic testing is identifying more women at risk for the genes, says Tuttle. Yet some women make the double mastectomy decision believing it will increase their odds of survival.

It won't. Women have an exaggerated perception of their risk of getting cancer in the other breast, Tuttle says. He was senior author of a study showing that women with cancer in one breast thought the risk of a tumor in the other breast was around 30 percent in the decade ahead. It's actually 4 to 5 percent.

And from personal experience, I know that doctors do not always present surgical choices in a fair-minded way. After my wife had been diagnosed with a tumor in each breast, our HMO's surgeon told her: "I can tell by the look on your face you're a worrier, so I'd recommend a double mastectomy."

I remember thinking, "Doc, if she didn't look worried, there'd be something wrong!"

My wife had always thought if she were diagnosed with breast cancer she'd say, "Off with my breasts." But the prospect of giving up her "girls" plunged her into a state of sorrow. She didn't want to say goodbye to part of herself. She was also aware that the mastectomy surgery was more invasive and recovery would take longer.

So she sought second and third opinions. They said a lumpectomy in each breast followed by chemotherapy and radiation offered Marsha the same survival odds.

Double lumpectomy is what Marsha chose. Thirteen years later, she is in good health.

As Marsha and I learned, the important thing is to talk to surgeons who devote a great portion of their practice to breast cancer — and then to make a decision that seems right to both doctor and patient.

In his practice, Tuttle sees the lumpectomy vs. mastectomy debate play out every day.

"A woman comes and she has a small breast cancer. Before I can even examine her, she'll say, 'I've already decided I want a double mastectomy,' " Tuttle told Shots.

He tells women that mastectomy takes four to six hours, compared with an hour for a lumpectomy. That the complication rate is low from lumpectomy and "moderate to high" for mastectomy. And that in many cases, with lumpectomy plus radiation, "there is absolutely no difference in survival for women who do not have hereditary breast cancer."

Some women will reply, "I didn't realize that." Others will say, "That's very interesting. When can I have my double mastectomy?"

As for the husband's role in this process, he needs to understand that it's not his job to tell his wife what to do. But that doesn't mean he's useless. He can act as a sounding board as his partner mulls over options. It helps, too, to say those three little words: "I love you." And then you'd be wise to follow the breast cancer husband's motto: Shut up and listen to your wife.